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Emmanuel Carrera, MD; Jan Claassen, MD; Mauro Oddo, MD; Ronald G. Emerson, MD; Stephan A. Mayer, MD; Lawrence J. Hirsch, MD

Arch Neurol. 2008;65(12):1612-1618.

Objectives  To determine the prevalence, predictors, and clinical significance of electrographic seizures (ESz) and other continuous electroencephalographic monitoring findings in critically ill patients with central nervous system infections.

Design  Retrospective cohort study.

Setting  Eighteen-bed neurocritical care unit.

Patients  We identified 42 consecutive patients with primary central nervous system infection (viral, 27 patients [64%]; bacterial, 8 patients [18%]; and fungal or parasitic, 7 patients [17%]) who underwent continuous electroencephalographic monitoring between January 1, 1996, and February 28, 2007.

Main Outcome Measures  Presence of ESz or periodic epileptiform discharges (PEDs).

Results  Electrographic seizures were recorded in 14 patients (33%), and PEDs were recorded in 17 patients (40%). Twenty patients (48%) had either PEDs or ESz. Of the 14 patients with ESz, only 5 (36%) had a clinical correlate. Periodic epileptiform discharges (odds ratio = 13.4; P = .001) and viral cause (odds ratio = 13.0; P = .02) were independently associated with ESz. Both ESz (odds ratio = 5.9; P = .02) and PEDs (odds ratio = 6.1; P = .01) were independently associated with poor outcome at discharge (severe disability, vegetative state, or death).

Conclusions  In patients with central nervous system infections undergoing continuous electroencephalographic monitoring, ESz and/or PEDs were frequent, occurring in 48% of our cohort. More than half of the ESz had no clinical correlate. Both ESz and PEDs were independently associated with poor outcome. Additional studies are needed to determine whether prevention or treatment of these electrographic findings improves outcome.

Author Affiliations: Comprehensive Epilepsy Center (Drs Carrera, Claassen, Oddo, Emerson, and Hirsch) and Division of Critical Care (Drs Carrera, Claassen, Oddo, and Mayer), Department of Neurology, The Neurological Institute, Columbia University Medical Center, New York, New York.

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